Abortion

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The Supreme Court’s Wisdom “ . . . we need not resolve the difficult question of when life begins. When those trained in the respective disciplines of medicine, philosophy, and theology are unable to arrive at any consensus, the judiciary, at this point in the development of man’s knowledge, is not in a position to speculate as to the answer.”

Fertilization complex process which takes 24 hours after penetration of the oocyte (egg) by the sperm
occurs in fallopian tube
complete when pronuclei (23 chromosomes) of sperm and oocyte fuse to form a new cell called a zygote (46 chromosomes)

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Stages of the pre-embryo . . . Zygote: one cell
Blastomere: 2-8 cells, it takes 20 hours for the first cell division
Morula: 8-16 cells. The morula travels out of the fallopian tube and reaches the endometrial cavity
Blastocyst: multicellular mass of cells with a fluid filled center

Abortion Termination of pregnancy before 20 weeks gestation calculated from date of onset of last menses
Early Abortion: before 12 weeks
Late Abortion: from 12-20 weeks
Delivery of a fetus of weight less than 500 grams

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Definitions . . . Induced Abortion: intentional medical or surgical termination of a pregnancy
Elective: if performed for a woman’s desires
Therapeutic: if performed for reasons of maintaining health of the mother

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Induced abortion: statistics . . . 1,180,000 abortions are reported to the CDC in 1997. This is constant since 1980
305 abortions/1000 live births
National abortion rate: 20/1000 women aged 15-44 79.7% of women obtaining abortions are unmarried
21 % of women obtaining abortions are younger 19 years old
55.2 % are younger than 24 years old

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Statistics, continued 53% of women in the United States having abortions have never had one before
88% of women who abort are in the first trimester of pregnancy
97% of women having first trimester abortions have no complications or post abortion complaints
2.5 % have minor complaints that are handled in a physicians office
<0.5% require additional surgery

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Induced abortion: safety Risk of death from a legal abortion is 0.4/100,000
Risk of death from a term pregnancy is 9/100,000

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Induced Abortion: safety Risk of death for being an abortion provider 20/100,000

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Historical Perspective “(T)here is every indication that abortion is an absolutely universal phenomenon, and that it is impossible even to construct an imaginary social system in which no woman would ever feel at least compelled to abort” Devereux G. A typological study of abortion in 350 primitive, ancient, and pre-industrial societies.

Roe vs. Wade 1/22/73 “We recognize the right of the individual, married or single, to be free from unwanted governmental intrusion into matters so fundamentally affecting a person as the decision whether to bear or beget a child. That right necessarily includes the right of a woman to decide whether or not to terminate her pregnancy.”

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Benefits of Legal Abortion Death from illegal abortion used to be a major component of maternal mortality
Hospital wards were filled with patients suffering from septic “spontaneous abortion”
In 1940, 1407 died from complications of induced abortion
1987 (last year of available data)
12 deaths from spontaneous abortion
6 deaths from legally induced abortion
2 deaths from illegally induced abortion

Dilatation and curettage (D&C) Removal of pregnancy contents by some mechanical means
Vacuum most commonly used
12-13 weeks is the upper limit of gestational age
Usually performed in free standing clinics

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D&C (vacuum curettage) The cervix must be dilated to permit larger diameter suction curettes
Premedication with NSAID
Local (paracervical block), spinal, conscious sedation, or general anesthesia

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Medical Abortion Mifepristone (RU486)
analogue of progestin norethindrone
strong affinity for the progesterone receptor, acting as an antagonist
a single oral dose given to women 5 weeks or less produces abortion in 85% of cases

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Medical Abortion - politics RU486 - Mifepristone
developed in 1980’s
approved for use by French government 1988
one day later manufacturer withdrew it from the market succumbing to international boycott
French government ordered redistribution
Prohibited in US during Reagan and Bush
Ban lifted by Clinton, clinical trials, preliminary FDA approval 9/96
Final approval stalled secondary to inability to manufacture and distribute until 9/2000

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Mifepristone protocol Women less than 49 days LMP with confirmed b-hCG
600mg mifepristone on day 1
On day three, return for prostaglandin, Misoprostil 400 mcg orally
Patient remain in clinic four hours, during which time expulsion of pregnancy usually occurs

Medical Abortion in the US Women less than 49 days LMP with confirmed pregnancy
Methotrexate 50 mg/m2 on day 1
Misoprostol 800mg intravaginally on day 5,6, or 7, repeat x 1 in 48 hours if pregnancy persists
Abortion off site in 1-5 days. Surgical intervention if pregnancy persists to day 29

D & E Mechanical and suction removal of formed pregnancy after cervical dilation
Technically more difficult than earlier suction procedures
Associated with fewer complications than instillation and suppository methods
General anesthesia is not required

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Picture of laminaria

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Intrauterine injection of abortifacients Prostaglandin, hypertonic saline, hypertonic urea are introduced by amniocentesis
Fetus and placenta are aborted vaginally
Osmotic dilators are used to decrease time to delivery and decrease complications

When those trained in the respective disciplines of medicine, philosophy, and theology areAbortion more

When those trained in the respective disciplines of medicine, philosophy, and theology areAbortion legal in US from Puritan settlement till mid 1800’s …www.dartmouth.edu/~phil03/handouts/Phil3_22NOV.ppt less